Gray and white matter abnormality in patients with T2DM-related cognitive dysfunction: a systemic review and meta-analysis

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Abstract

Aims/hypothesis

Brain structure abnormality in patients with type 2 diabetes mellitus (T2DM)-related cognitive dysfunction (T2DM-CD) has been reported for decades in magnetic resonance imaging (MRI) studies. However, the reliable results were still unclear. This study aimed to make a systemic review and meta-analysis to find the significant and consistent gray matter (GM) and white matter (WM) alterations in patients with T2DM-CD by comparing with the healthy controls (HCs).

Methods

Published studies were systemically searched from PubMed, MEDLINE, Cochrane Library and Web of Science databases updated to November 14, 2021. Studies reporting abnormal GM or WM between patients with T2DM-CD and HCs were selected, and their significant peak coordinates ( x, y, z) and effect sizes ( z-score or t-value) were extracted to perform a voxel-based meta-analysis by anisotropic effect size-signed differential mapping (AES-SDM) 5.15 software.

Results

Total 15 studies and 16 datasets (1550 participants) from 7531 results were involved in this study. Compared to HCs, patients with T2DM-CD showed significant and consistent decreased GM in right superior frontal gyrus, medial orbital (PFCventmed. R, BA 11), left superior temporal gyrus (STG. L, BA 48), and right calcarine fissure / surrounding cortex (CAL. R, BA 17), as well as decreased fractional anisotropy (FA) in right inferior network, inferior fronto-occipital fasciculus (IFOF. R), right inferior network, longitudinal fasciculus (ILF. R), and undefined area (32, −60, −42) of cerebellum. Meta-regression showed the positive relationship between decreased GM in PFCventmed.R and MoCA score, the positive relationship between decreased GM in STG.L and BMI, as well as the positive relationship between the decreased FA in IFOF.R and age or BMI.

Conclusions/interpretation

T2DM impairs the cognitive function by affecting the specific brain structures. GM atrophy in PFCventmed. R (BA 11), STG. L (BA 48), and CAL. R (BA 17), as well as WM injury in IFOF. R, ILF. R, and undefined area (32, −60, −42) of cerebellum. And those brain regions may be valuable targets for future researches. Age, BMI, and MoCA score have a potential influence on the altered GM or WM in T2DM-CD.

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Most cited references 61

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The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration

Alessandro Liberati, Douglas G. Altman, Jennifer Tetzlaff … (2010)

Systematic reviews and meta-analyses are essential to summarise evidence relating to efficacy and safety of healthcare interventions accurately and reliably. The clarity and transparency of these reports, however, are not optimal. Poor reporting of systematic reviews diminishes their value to clinicians, policy makers, and other users. Since the development of the QUOROM (quality of reporting of meta-analysis) statement—a reporting guideline published in 1999—there have been several conceptual, methodological, and practical advances regarding the conduct and reporting of systematic reviews and meta-analyses. Also, reviews of published systematic reviews have found that key information about these studies is often poorly reported. Realising these issues, an international group that included experienced authors and methodologists developed PRISMA (preferred reporting items for systematic reviews and meta-analyses) as an evolution of the original QUOROM guideline for systematic reviews and meta-analyses of evaluations of health care interventions. The PRISMA statement consists of a 27-item checklist and a four-phase flow diagram. The checklist includes items deemed essential for transparent reporting of a systematic review. In this explanation and elaboration document, we explain the meaning and rationale for each checklist item. For each item, we include an example of good reporting and, where possible, references to relevant empirical studies and methodological literature. The PRISMA statement, this document, and the associated website (www.prisma-statement.org/) should be helpful resources to improve reporting of systematic reviews and meta-analyses.

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Cognitive decline and dementia in diabetes mellitus: mechanisms and clinical implications

Florin Despa, Geert Biessels (2018)

Cognitive dysfunction is increasingly recognized as an important comorbidity of diabetes mellitus. Different stages of diabetes-associated cognitive dysfunction can be discerned, with different cognitive features, affected age groups, prognosis, and likely also different underlying mechanisms. Relatively subtle, slowly progressive cognitive decrements occur in all age groups. More severe stages, particularly mild cognitive impairment and dementia, with progressive deficits, occur primarily in older individuals. The latter are clearly most relevant for patient management and are the focus of this review. Evolving insights from studies on risk factors, brain imaging, and neuropathology provide important clues on mechanisms. In the majority of patients multiple etiologies likely determine the cognitive phenotype. Although both the risk of -clinically diagnosed- Alzheimer’s disease and that of vascular dementia is increased in association with diabetes, the cerebral burden of the prototypical Alzheimer’s pathologies is not. A major challenge is therefore to pinpoint from the spectrum of diabetes-related disease processes those that affect the brain and contribute to development of dementia beyond Alzheimer’s pathologies. Observations from experimental models can help to meet that challenge, but this requires further improving the synergy between experimental and clinical scientists. Development of targeted treatment and preventive strategies depends on these translational efforts.

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Is Open Access

Type 2 diabetes in East Asians: similarities and differences with populations in Europe and the United States

Ronald CW Ma, Juliana Chan (2013)

There is an epidemic of diabetes in Asia. Type 2 diabetes develops in East Asian patients at a lower mean body mass index (BMI) compared with those of European descent. At any given BMI, East Asians have a greater amount of body fat and a tendency to visceral adiposity. In Asian patients, diabetes develops at a younger age and is characterized by early β cell dysfunction in the setting of insulin resistance, with many requiring early insulin treatment. The increasing proportion of young-onset and childhood type 2 diabetes is posing a particular threat, with these patients being at increased risk of developing diabetic complications. East Asian patients with type 2 diabetes have a higher risk of developing renal complications than Europeans and, with regard to cardiovascular complications, a predisposition for developing strokes. In addition to cardiovascular–renal disease, cancer is emerging as the other main cause of mortality. While more research is needed to explain these interethnic differences, urgent and concerted actions are needed to raise awareness, facilitate early diagnosis, and encourage preventive strategies to combat these growing disease burdens.

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Author and article information

Contributors

Wen Wang:

ORCID: http://orcid.org/0000-0001-6473-4888

wangwen@fmmu.edu.cn

Lin-Feng Yan:

ORCID: http://orcid.org/0000-0001-8824-6117

ylf8342@163.com

Guang-Bin Cui:

ORCID: http://orcid.org/0000-0002-6908-0788

cuigbtd@163.com

Journal

Journal ID (nlm-ta): Nutr Diabetes

Journal ID (iso-abbrev): Nutr Diabetes

Title: Nutrition & Diabetes

Publisher: Nature Publishing Group UK (London )

ISSN (Electronic): 2044-4052

Publication date (Electronic): 15 August 2022

Publication date PMC-release: 15 August 2022

Publication date Collection: 2022

Volume: 12

Electronic Location Identifier: 39

Affiliations

[1 ]GRID grid.460007.5, ISNI 0000 0004 1791 6584, Department of Radiology, , Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), ; 569 Xinsi Road, Xi’an, 710038 Shaanxi China

[2 ]GRID grid.233520.5, ISNI 0000 0004 1761 4404, Student Brigade, , Fourth Military Medical University (Air Force Medical University), ; 169 Changle Road, Xi’an, 710032 Shaanxi China

Author information

Wen Wang http://orcid.org/0000-0001-6473-4888

Lin-Feng Yan http://orcid.org/0000-0001-8824-6117

Guang-Bin Cui http://orcid.org/0000-0002-6908-0788

Article

Publisher ID: 214

DOI: 10.1038/s41387-022-00214-2

PMC ID: 9378704

PubMed ID: 35970833

SO-VID: be6fec89-a2f0-4788-95c9-edf1422f0e11

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 22 January 2022

Date revision received : 5 July 2022

Date accepted : 15 July 2022

Funding

Funded by: Military Medical Enhancement Program of Air Force Medical University 2018JSTS13

Funded by: FundRef https://doi.org/10.13039/501100001809, National Natural Science Foundation of China (National Science Foundation of China);

Award ID: 81771815

Award Recipient : Guang-Bin Cui

Funded by: Military Medical Enhancement Program of Air Force Medical University 2018HKPY03

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ScienceOpen disciplines: Endocrinology & Diabetes

Keywords: type 2 diabetes,cognitive neuroscience

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ScienceOpen disciplines: Endocrinology & Diabetes

Keywords: type 2 diabetes, cognitive neuroscience

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Gray and white matter abnormality in patients with T2DM-related cognitive dysfunction: a systemic review and meta-analysis

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Most cited references 61

The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration

Cognitive decline and dementia in diabetes mellitus: mechanisms and clinical implications

Type 2 diabetes in East Asians: similarities and differences with populations in Europe and the United States

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